Cardiology · General Practice · 2 h ago
NICE 2025 update recommends earlier initiation of heart failure therapies
A British Journal of General Practice article describes changes in the 2025 NICE chronic heart failure guideline. For HFrEF and most HFmrEF, it says the guideline recommends prescribing four key medication classes unless contraindicated, with treatment started promptly rather than waiting to maximize each drug’s dose.
- NICE recommends four drug classes for HFrEF unless contraindicated.
- Most people with HFmrEF are also covered.
- Start therapies promptly; do not wait for maximal titration.
The article outlines changes in the 2025 NICE chronic heart failure guideline for primary care. It contrasts the updated recommendations with the 2018 stepwise approach, which began with an ACE inhibitor and beta-blocker for heart failure with reduced ejection fraction (HFrEF; LVEF ≤40%) and added other treatments later. The excerpt identifies the four classes as ACE inhibitors, beta-blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors.
The updated guideline recommends all four classes for people with HFrEF and for most people with heart failure with mildly reduced ejection fraction (HFmrEF; LVEF 41%–49%), unless contraindicated. It emphasizes starting each medication as soon as possible, without first titrating other agents to their maximal doses.
The article presents this as a change in treatment sequencing intended to help translate trial advances into improved outcomes in practice. The supplied text is an incomplete excerpt and does not provide detailed implementation advice, evidence tables or the full guideline recommendations; clinicians should consult the full NICE guideline for those details.
In practice
For people with HFrEF and most people with HFmrEF, the 2025 NICE guideline, as described in this article, recommends ACE inhibitors, beta-blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors unless contraindicated. It shifts away from waiting to maximize one medicine before adding another, instead aiming to start each as soon as possible. This is a guideline recommendation, not evidence from a new trial; the supplied excerpt is incomplete and does not specify detailed implementation or exceptions, so the full NICE guidance should be consulted.
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British Journal of General Practice: NICE chronic heart failure guideline update: implications for primary care ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.